dr jignesh vora

1. Goiter
Sub-Title

2. intro
• is swelling of neck due to enlarged thyroid
gland
• simple goiter is usually not cancer
• toxic goiter is enlarged thyroid with small ,
rounded growth
• can occur in hyperthyroidism, hypothyroidism
& normal thyroid function ( euthyroidism)
• in goitre thyroid may functioning properly or
not

3. types
• endemic - due to iodine defi
• sporadic - individual is affected ( age > 40 , F/H
, F> M)

4. morphology ac to size
• class 1 - palpation struma ( can't be seen only
found by palpation)
• class 2 - struma is palpative & can b seen
easily
• class 3 - struma is very large & retrosternal,
pressure results in compressive marks

5. morphology ac to growth pattern
• uninodular ( struma uninodulosa) may b
inactive or toxic nodule
• multinodular ( struma nodosa) - toxic
• diffuse (struma diffuse) - whole thyroid is
enlarged

6. thyroid nodules - two types
• hot or warm - 15% , hyperthyroidism, low CA
risk
• cold - 85% , 20% of these r CA

7. Thyroid CA - risk factors
• ch goiter
• F/H
• F> M
• radiation exposure

8. causes
• Iodine deficiency 90%(increased size of
thyroid may be permanent if untreated for
around five years)
• Congenital hypothyroidism Inborn errors of
thyroid hormone synthesis Hypothyroidism
• Goitrogen ingestion
• iodine neutralizing food ( cabbage, cauliflower,
broccoli)
• soyabean

9. gen symptoms
• enlarged thyroid gland
• breathing & swallowing difficulty due to
pressure on trachea & esophagus respectively
• cough
• hoarsness

10. sign & symptoms
• if due to hyperthyroidism (due to adrenergic
stimulation) - tachycardia, palpitations, heat
intolerance, hypermetabolism , wt loss,
exophthalmos
• if due to hypothyroidism - wt gain despite
poor appetite, cold intolerance, lethargy ,
constipation

11. investigation
• TSH
• FT3 / R3
• FT4 / T4
• FT4I ( index)
• ultrasound scan
• FNAC
• RAIU
• thyroid antibody test

12. interpretation of lab value
• high TSH & low FT4 /FT4I - primary
hypothyroidism
• low TSH & low FT4 / FT4I - hypothyroidism
due to pituitary gland
• low TSH & high FT4 /FT4I - hyperthyroidism

13. T3 test
• to dx severity of hyperthyroidism
• if hyperthyroidism - high T3
• high TSH & T3 but FT4 / FT4I is normal in some
hyperthyroidism
• rarely helpful in hyperthyroidism
• pt can b severely hypothyroidism with high
TSH & low FT4 / FT4I but T3 is normal
• during preg & un women who r taking OCs T3
is high ( E increases binding proteins)

14. Thyroid antibody test
• anti thyroid peroxidase & anti thyroglobulin
antibodies
• if hyperthyroidism & positive antibodies test
then autoimmune thyroid disease
• if hypothyroidism & positive antibodies test
then hashimoto thyroiditis

15. thyroglobulin - Tg
• doesnt measure thyroid function
• doesnt dx thyroid cancer

16. RAIU - radioactive iodine uptake
• T4 contains much iodine so thyroid must pull
large amount of iodine to make T4
• pt has to swallow small amount of radioactive
iodine
• radioactivities track where iodine molecules
go
• if RAIU is high - hyperthyroidism
• if RAIU is low - hypothyroidism

17. Rx
• if hyperthyroidism - radioactive iodine to
shrink gland
• if iodine defi - lugol's iodineo or KI solution ,
seafood
• if hypothyroidism - thyroxine replacement
• benign nodules - shrunk or destroyed by
radioactive iodine or Sx
• in extreme cases like CA - partial or complete
thyroidectomy & radioactive iodine

18. prognosis
• good
• goiter may disappeare or becomes larger
• swelling stays if > 5 yrs